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HomeMy WebLinkAbout038-1072-60-000 \ 0 2 7 \ j C, / 0 . � \ � $ � 7 � 7 � a \ � ) k cc 2 0 3 'r- <1 « 2 / \ E z2 22 I- § ) a ■ § § B « 2 \ IZ _ . - k k 7 D k / E 2 7 0 ] § 2 I ) b Q } cok } " z 2 2 m ~ e 2 = g o CL : LO a M c c L : C-4 2 a ■ a g 0 CD 0 2 2 E { / ) < \ � ® U) t � - k (D a 2 a I co -1 0 0 k k � m p = r § \ E ® ) ; f I � g ■ ■ � $ LL ° / ) k ® o - ® : o a ® CD 8 \ q k E § ; § a @ 2 o ) t _ / § 5 2 - A � \ c k ® § j \ : � / 0 2 ) / / 2 \ � © � 2 } m : ) E ) k a i IL k 2 a 0 2 J Parcel #: 038-1072-60-000 08/14/2006 09:48 AM PAGE 1 OF 1 Alt. Parcel#: 17.31.18.301 F 038-TOWN OF STAR PRAIRIE Current ,X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-BURKE, KEVIN J KEVIN J BURKE 924 214TH ST SOMERSET WI 54025 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description "924 214TH ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 3.540 Plat: N/A-NOT AVAILABLE SEC 17 T31 RI 8W PT NE SW 3.54 AC LOT 5 Block/Condo Bldg: OF CSM V 5/1231 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-31N-18W Notes: Parcel History: Date Doc# Vol/Page Type 09/20/1999 610655 1457/489 WD 07/23/1997 788/623 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.540 47,200 199,600 246,800 NO Totals for 2006: General Property 3.540 47,200 199,600 246,800 Woodland 0.000 0 0 005•. Totals for 2 Property 9 General Pro p Y 1 9 600 246 800 3.540 47,200 , , Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: 223 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I w PUMP CHAMBER Manufacturer: �,[J�� _ Liquid Capacity: ®� Pump Model: _ �63 Pump/Siphon Manufacturer: ZDE' l� Pump Size Elevation of inlet: fe, yQ Bottom of tank elevation: �Q P�CZ� Pump off switch elevation: Z ,,5,- Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: 5a r-I Number of feet from nearest property line: Front, O Side, Rear,0 Ft. �� Number of feet from well:� 70- Number of feet from building: Ie r (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: y Length:'Y 2 Number of Lines: L Area Built:. Fill depth to top of pipe: yQ �` Number of feet from nearest property line: Front, O Side, (Rear,O Ft .� � Number of feet from well: �YY Number of feet from building: ati (Include distances on plot plan). SEEPAGE PIT ize: Number of pits: Diameter: Liqui depth: Bottom of seepage pit elevation: Area Built: Has either a drop box or distribution box O been used any of the above soil absorbtion sytems? (Check o ). HOLDING TANK Manufacturer: apacity: Number of rings used: evatio of bottom of tank: Elevation of inlet: Number of feet from rest property line: Front, Side, O Rear, OFt. lo Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: a Inspector• Dated: LS-- Plumber on job: d License Number: 3/84:mj Form - S T C 4-404 AS BUILT SANITARY SYSTEM REPORT OWNER �/y 1 T1�— TOWNSHIP ��d ,P"a4 SEC. �Z T - LN-R -W ADDRESS /?T / ST. CROIX COUNTY, WISCONSIN 1FOM�_/nE7- LC/s SUBDIVISION C/�/+7,Q/�/ LOT S_ LOT SIZE 3, ej PLAN VIEW Distances and dimensions to meet requirements of I•1HR 83 i SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM J fi c f/DUSE WELL 50 `�6 r l 000 Q-AL 5'rT ?Ot 13y ' Soo &Ac PC, 90 v- Y �qrq? INDICATE NORTH ARROW sE-�pACC- 13ED AT TfIE ME, 4 o T Co,?NE/l BENCHMARK: Describe the vertical /reference point used 6A1- 7el-) - Cc ,_5C-Cl �YfA/?��-� Elevation of vertical reference point: /00 Proposed slope at site: SEPTIC TANK: Manufacturer: (i�/ )C Liquid Capacity: 1406 Number of rings used: QN Tank manhole cover elevation: 10S_,40 Tank Inlet Elevation ,53� Tank Outlet Elevation: f03. y6 Number of feet from nearest Road: Front,(Q11 Side 0 Rear, O 266± feet From nearest property line Front,0 Side,009\Rear,O 136 ' feet Number of feet from: well .� t �° 0 , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) L SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS —tABOA&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON WI 53707 NE'-,, SW-4, S17,T31N-R18W 000NVENTIONAL ❑ALTERNATIVE State Plan I.D.Numbar: (If asstgnedl Town of Star Prairie El Holding Tank El In-Ground Pressure ❑Mound Lot 5 Germain Addition NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Timothy Meyer Route 1, Somerset WI 54025 '�� . 3 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV: CST REF.PT.ELEV. Name of Plumber: MP/MPRSW No.: County: Samtary Permit Number: onavin Schmitt I3205 St. Croix 102839 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER Y V v P OVI ED. PROVIDED YES ❑NO ❑YES NO BEDDING: VENT DIA.. VENT MATL.: HIGH WATER NUMBER OF ROAD. PROPERTY WELL. BUILDING. AIR NLOET RESH ALARM. FEET FROM LINE �EYES / NO ❑YES ❑NO NEAREST 00� DOSING CHAMBER: MANUF CT RER BEDDING'. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCK I NG COVER ,Gt/"� ©/� PROM ED PROVIDED: ES ❑NO `� `^"�'�� ES ENO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL ENEAREST ER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN ,��,// FROM uNE AIR INLET PUMP ON AND OFF) �, LYYES 0 N / SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing DIAMETER MATERIAL AND MARKING FORCE Or excavation. (If soil can be rolled into a wire,construction shall cease until /l the soil is dry enough to continue.) MAIN 7 CONVENTIONAL SYSTEM: WI TH'. LEN H NO.OF DISTR.PIPE SPACJ NG. COVER JINSIDE DIA nP1T5 LIQUID BED/TRENCH TRENCHES L MATERIAL' PIT DEPTH DIMENSIONS J r GRAVEL DEPTH FILL DE P H UISTH.PIPF DISTR PIPE DISTR.PIPE MATERIAL. NO DISTR NUMBER OF PROPERTY WELL BUILDING VENT TO FRESIt BELOW PI ES!! ABOVE O^V ER E EV`IN ET ELEV ND'. PIPES FEET FROM LI� ?/, / ) At ET VJd NEAREST ,)V ��/ ,S(�O MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES 1:1 NO SOIL COVER ITEXTURE PERMANENT MARKERS JOIIIEHVATIIIN WELLS 1:1 YES ❑NO ❑YES NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED JbEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ❑YES 1:1 NO 1:1 YES ❑NO DYES El PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PI FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.­PIPE MATERIAL IND DISTR IDI STR.PIPE DISTRIBUTION PIPE MATERIAL&MAHKING ELEV. ELEV. DIA.. ELEV, PIPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING GRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED ANS ❑YES ONO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER of PROPERTY WELL: BUILDING. 3 FEET FROM LINE S ❑YES F-1 NO DYES El NO NEAREST L/ Sketch System on tain in county file for audit. Reverse Side. SIG TITLE. DILHR SBD 6710(R.01/82) / Zoning Administratnr I INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT ' APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I Property owners name and mailing address. Provide the legal description where the system is to be installed; Il. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 111. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; Vill. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground at included the creation of surcharges (fees) for a number of regulated practices which Wisco E!Cl`S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasur is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. 0 �17e ironies r.ollected through these surcharges are credited to the groundwater fund adminis- tc re:: by the `department of Natural Resources. These funds are used for monitoring ground- t ater, groundwater contamination investigations and establishment of standards. Groundwater, is worth protecting. 5 3D-6398(R.03/86) 1:=ffq1jLn SANITARY PERMIT APPLICATION COUP In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# –Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. –See reverse side for instructions for completing this application. PETITION -71 1. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ZC J NO PROPERTY OWNER PROPERTY LOCATION C E'/4 SjV %4, S J2 T , N, R E(or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME J e;F CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROB,LAKE OR LANDMARK VILLAGE, % /70 II. TYPE OF BUILDING OR USE SERVED: � , 03'&— /07c2- O-00Q Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. VN New b.❑ Replacement c. ❑Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. X Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. seepage Bed b. ❑seepage Trench c. ❑seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): © , Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App [Tanks;1 Tanks structed Septic Tank or Holdina Tank -S Lift Pump Tank/Siphon Chamber X / t f IN ❑ I ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system show attached plans. Plumber's Name(Print): Plumber' Signature:(No Stamps /MPRSW No.• Business Phone Number: i P umber's Address(Street,City,State,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# 1)j5WAf1 CST's ADDRESS(Street,City,State,Zip Codle)if Phone Number: f ° IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate gent Signature(No Stamps) rcharge Fee Approved ❑ Owner Given Initial ( �� Adverse Determination I�Cl X. COMMENTS/REASONS FOR DISAPPROVAL: k� SBD-6398(formerly Plb-67)(R.03186) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber � t APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property z�,3 a Location of Property_-kT��, Section , T ;/ N-R_J8 W Township Nailing Address T Address of Site T / Subdivision llama C�ERr.4/�f �t�.�/�•i p-/�At . . Lot number Previous Owner of Property J,ALE �rE2t Z-A/A4' Total Size of Parcel a 14Cv-e Date Parcel was Created zz Are all corners and lot lines identifiable? _ Yes No Is this property being developed for resale (spec house) ? Yea _ X _ No Volume . U ,■ and Page Number "3 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - r: PROPERTY OWNER CERTIFICATION I (Wel cmti6y that &a atatement6 on ti"' ohm ah.e tAue to the but o6 my (ouA) hncwtedge; that (we) am (she) -the owneh(a� o6 the phopehty duci,ibed in thiA in6o4mation 6ohm, by viAtue 06 a waAAanty deed kecoh.ded in the 066.ice o6 the Col.vi.tyy RegiAteh. o6 Deeds as Document No. ; and that I (We) pheaentty sun -the p4opoaed zite 6oh. the Sewage I * poa aya em (oh. I (we) have obtained an ea.eemewt, to nun with .the above de%chibed ph.opehty, bon the conatAucti.on 06 said system, and the same hae been du.t necohded .tn the 066tee- o6 the County Regi4teh. o6 Heeds, dA Doewn No. r SIGNATURE OZ? OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 7 DATE SIGNED DATE SIGNED r a — ill II i i II 11 I � 11 ill i Ili Ills i I I _ I -- 1 - - I I I - i I , - t - J-4 --- - -- - -- r - - - - - - i- iT I I - t , i- AC ti - Y i i I f f - I i I I t I 1 I I I I ' rt I j ; � I fI -. -- t -a - a z r . H a STC - 105 rr� ` a H SEPTIC TANK MAINTENANCE AGREEMENT 0 St . Croix County z d a OWNER/BUYER T/y%OTHy I�LSSs�/2 ROUTE/BOX NUMBER art/ Fire Number CITY/STATE j- j; ZIP 5/0,2 3- PROPERTY LOCATION : , �(,�_'�, Section , TN , R W, Town of St . Croix County, Subdivision 6��/?/l'flly Lot number -- Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed, by a licensed septic tank pumper . What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- Iv ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SIGNED DATE / 2—A ft St . Croix County Zoning Office P.0. Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address . ,. Corduw 7?!!=2[ INDIANHEAD OF NEW RICHMOND, INC. 346 S. Main New Richmond, Wisconsin 54017 (715) 246-2129 87 -C-0 `J1u�-�-•_ ��� �� �:� -CSC.-f:,.� � ,,�z�.�' -7 Each Office Is Independently Owned And Operated REALTOR" i ra `W 11,V cd 7 �'/9 F SAFETY&BUILDINGS DEPARTMENT OF REP ON SOIL BORINGS AND DIVISION INDUSTRY, P.O. BOX 7969 LABOR AND LABOR RELATIONS PERCOLATION TESTS (115) MADISON,WI 53707 (H63.09(1)&Chapter 145.045) 'tt Q 1-vt ;LO N S ON OWNS HIP/A...... 1?A,b1�,.Y: UT NNO.:BLK.NO.: SUBDIVISION NAME: V w,/ / U u n ■( Sf MAI I AD RESS:NTY 0/N R' B ERAME 1 .S�v �S/aa-•3� USE DATES OBSERVATI NS MADE NO.BEDRMS: COMMERCIAL D SCRIPTION: S: STS: Residence —3 '1 ❑Replace 1 7- �_ L�Q 7—�_ Q so:/ MA? /7� llllOt OirY �dq RATING:S-Site suitable for system U-Site unsuitable for system [CONVENTIONAL: MOUNccD: IN-GROUND STEM-INN FILL rEJS i5LDIING TANK:RE^COMMENDED SYSTEM:(optional) ®J ®J ®fa7 EJ 90 U C s� d If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: �(t Floodplain,indicate Floodplain elevation: P OFILE DESCRIPTIONS BORING TOTAL$ P HTOGROU NDWATER,aNeoiES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTFUAM ELQECVATION OBSERVED EST. p H TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) e. Y ,& 99 � .a, .B / �3 sl PERCOLATION TESTS TEST DEPTH* WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATPER INCH ES NUMBER 4AiGi4&&9 AFTERSWELLING INTERVAL-MIN. I I p. o' 0 3 0 31D P- o' Alc P__ r• i P P. 3 _ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances.Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show� the surface elevation at all borings and the directions d percent of land slope. ?r t.4f -z S•jc no ' A#C•� a 1,,2.sV SYSTEM ELEVATION y -7- =r / ._- _ - I _e �s r F-- ( A dot d � �'I/• r 1,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures an mgOods sp�fi the VVls sin Administrative Code,and that the data recor ed and the location of the tests are correct to the best of my knowledge and belie ��er�. r.�... (I',) 7b 1A,v.',d'A;A Pe-�s�oi A a-• �. , NAME riot : TESTS WERE COMPL ON: % ok ea.0 ' r.s ADD ESS: CERTIFICATION NUMB ONE NUMBER( 3onal): / joat Ave c < 11016 /M CS N TU E: i LDISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. _... . ..none io noia7l —OVER — EH 115 'R�, enB f REPORT ON SOIL BORINGS AND PERCOLATION TESTS "w ' ,. . WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES ' �,�„t: • ', ,.<, ., "-P ' P.O.BOX 309,MADISON,WISCONSIN 53701 LOCATION:. T ship or.Municipality�4,5) .SectionJ — .� tK• .,.:. � v'` !r ,e.- .�iwiN15 ♦r'r/r'f. irf.,� Lot No. ,,Slock.No., County , }!' ` ivision Name fJuKner's/Buyeits.Name. 06 r t, r ?r rI P• w ,r�<' • Mailing"Addres � -.. s'- i PE OF OCCUPANCY:' Residence No.of Bedrooms -� COMMERCIAL F „ EFFLUENT DISPOSAL SYSTEM:,NEW. X REPLACEMENT ALTERNATE SYSTEM OTHER DATE$OBSERVATIONS MADE: SOIL BORINGS ?"x`�' PERCOLATION.TESTSv. �dYtladpFllba..blwntiwWwri. .•. �._. ... _ .. SOIL MAP SHEET / NAME OF.SOIL MAP UNIT PERCOLATION TESTS HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHE TEST DEPTH i, HARACTER OF SOIL SINCE HOLE HOLE AFTE INTERVAL RATE NUM INCHES , ;THICKNESS IN INCHES MIN/IN k:BER •; 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 EL 30 '(4) 30 °" j/ By "P ,�l,•� �� Al, 3 v s y yv b1.; P— P-r , SOIL BORING TESTS »� E DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, t TOTAG`DEPTH TEXTURE,MOTTLING AND DEPTH TO BEDROCK • .INCHES: OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES b",42 � fly RLAN•VIEW(Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location atic�square feetof suitable areas: �9 ?°e.# ���• � , ladle number of square feet of absorption area needed for building type and occupancy°'' -' 0 Indicate scale or distances. Givo j wj,i4untal and:vertical reference points.Indicate slope. v: � 'J t °-Q' ,�r t c s !1 s J r�%< y4 t �• p 0 . sa Arc S �I D Q N s-0 rW 91 Fl. } 2 t r•. i >„Vii .� �C) c I i, yy 5 vs P1'. if sr�b . , to =� •; t �� ,z ` a 4: T1 7 .�'�I,the undersigend,hereby ceiRify that the soil tests reported on fhb,form. rMlt accord wlth'the-P�ooadunu and methods x � specified is the Wisconsin Administrative Code,and that the data i�acorded7yid< of t holes are correct to the•best of my Ate,i, knowiedge and belief• �.' 19�� • w. !./PAl r�� c � Ar, �, « Cettif�catiml No �.Name(print) C10 Name Of.installe'r if known CST Signature t CoDV D-File Coax For Soil ate� Te